CLINICAL AND PATHOGENETIC RATIONALE FOR THE USE OF MAGNESIUM PREPARATIONS IN PREGNANT WOMEN WITH ISTHMIC CERVICAL INSUFFICIENCY AND UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA


Citar

Texto integral

Acesso aberto Acesso aberto
Acesso é fechado Acesso está concedido
Acesso é fechado Acesso é pago ou somente para assinantes

Resumo

Objective. To provide a clinical and pathogenetic rationale for obstetric management tactics for pregnant women with isthmic cervical insufficiency (ICI) and undifferentiated connective tissue dysplasia (UCTD) on the basis of complex studies, including molecular biological ones. Subjects and methods. A retrospective analysis of delivery records was made in 532 women and a prospective series of studies was conducted in 140 women with ICI of varying genesis. Genotyping was carried out using polymerase chain reaction; a biochemical study of the levels of magnesium was made in peripheral blood and saliva; the peripheral blood concentrations of matrix metalloproteinases were measured by enzyme immunoassay. Results. The most common markers of UCTD were tall stature, varicosity, mitral valve prolapse, myopia, and neurocirculatory dystonia. Various gestational complications, poor pregnancy outcomes, complicated labor, and birth of premature babies were more frequently noted in groups of pregnant women with functional ICI and those with ICI of mixed genesis. The clinical and laboratory patterns of magnesium deficiency were found in all groups of the examinees, the most pronounced magnesium deficiency being in the pregnant women with ICI of functional genesis. Study of HLA class I showed that the frequency of HLA-B35 antigen was significantly increased as compared to the general population. The significantly higher frequency of the A allele of the ESR-2014 G > A gene (OR 6.57, 95% CI 1.96—22.02), detected in pregnant women with the prolapsed fetal bladder, suggests that carriage of the A allele of the ESR-2014 G>A gene is a risk factor for threatening premature labor. Conclusion. A detailed analysis of the data obtained on ICI-UCTD relationships could confirm the contribution of UCTD to the development of a variety of obstetric complications and define ICI as a visceral marker of UCTD. The findings will promote obstetric alertness and rational management tactics for pregnant women with UCTD.

Texto integral

Acesso é fechado

Sobre autores

Z. KHODZHAYEVA

Academician V. I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health and Social Development of Russia

Email: zkhodjaeva@mail.ru

S. GURBANOVA

Academician V. I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health and Social Development of Russia

Bibliografia

  1. Городецкий В.В. Препараты магния в медицинской практике: малая энциклопедия магния. — М.: Медпрактика, 2004.
  2. Громова О.А. Молекулярные механизмы воздействия магния на дисплазию соединительной ткани // Журн. для практикующих врачей. — 2008. — № 1. — С. 23—32.
  3. Клеменов А.В. и др. Особенности течения беременности у женщин с недифференцированной дисплазией соединительной ткани // Пробл. репрод. — 2005. — № 3. — С. 85—88.
  4. Козинова О.В., Мельник Е.В., Бархина Т.Г. Морфофункциональная характеристика плодных оболочек при недифференцированной дисплазии соединительной ткани у матери: Материалы IV съезда акушеров-гинекологов России. - М., 2008.
  5. Коненков В.И. Глотов А.В. Иммуногенетическая детерминированность жизненного цикла больных дисплазией соединительной ткани: Материалы VII международной конференции. - Ставрополь, 2005.
  6. Кошелева Н.Г. Лечение и профилактика поздних гестозов препаратами магния: Метод. указания. - СПб., 2002.
  7. Кудинова Е.Г. Характеристика ранних сроков беременности у женщин с недифференцированными коллагенозами: Заочная электронная конференция «Диагностика, терапия, профилактика социально значимых заболеваний человека», 2009.
  8. Смольнова Т.Ю., Смольнова А.С., Адамян Л.В., Ляшко Е.С. Ассоциированная патология органов малого таза и тазового дна у больных с дисплазией соединительной ткани: Материалы Первой Всероссийской. научнопрактической конференции // Омский науч. вестн. - 2005. - Т. 32, № 5. - С. 83—84.
  9. Burke C., Morrison J. J. Perinatal factors and preterm delivery in an Irish population // J. Perinat. Med. - 2000. - Vol. 28. -P. 49—53.
  10. Cochrane database of Systematic Reviews 2002; Issue 1. Art. No.: CD000121. doi: 10.1002/14651858.CD000121.
  11. Hazardous chemicals in human and environmental health. — WHO, 2002. — P. 312.
  12. Heaps B.R., House M., Socrate S. et al. Matrix biology and preterm birth / Eds. F. Petraglia, J.F. Strauss III, S.G. Gabbe, G. Weiss. — Oxford: Informa Press, 2007. — P. 70-93.
  13. Jean Durlach. New data on the importance of gestational Mg deficiency // J. Am. college of nutrition. - 2004. - Vol. 23, № 6. - P. 6945—7005.
  14. Jorgensen A.L., Alfirevic Z., Smith C. T. Cervical stitch (cerclage) for prevention pregnancy loss: individual patient data meta-anakysis // Int. J. Obstet. Gynecol. - 2007. -P. 1460—1476.
  15. Matthias Winkler, Werner J. Rath. Changes in the cervical extracellular matrix during pregnancy and parturition // Perinatal medicine. - 1999. - Vol. 27. - P. 45—61.
  16. Nagase. H. Matrix metalloproteinases 1, 2 and 3: Substrate specificities and activation mechanisms / Eds. P.C. Leppert, J.F. Woessner. The еxtracellular matrix of the uterus, cervix and fetal membranes: synthesis, degradation and hormonal regulation. — New York, 1999. — P. 28-44.
  17. Nicolas M. Orsi Genetics of preterm labour // Best Pract. Res. Clin. Obstet. Gynaecol., Pret. Lab. — 2007. — Vol. 21, № 5. — P. 757—772.
  18. Rachael Simcox. Cervical cerclage in the prevention of preterm birth // Best Pract. Res. Clin. Obstet. Gynaecol., Pret. Lab. — 2007. - Vol. 21, № 5. - P. 831—842.
  19. Romero R., Erez O., Espinoza J. Intrauterine infection, preterm labour and cytokines // J. Soc. Gynec. Invest. — 2005. — Vol. 12. — С. 12463—12465.
  20. Schimatschek H.F., Rempis R. Prevalence of hypomagnesemia in an unselected German population of 16,000 individuals // Magnes Res. — 2001. — Vol. 14, № 4. — Р. 283-290.
  21. Sennstrom Maria B. et al. / Molecular Human cervical ripening, an inflammatory process mediated by cytokines // Hum. Reprod. - 2000. - Vol. 6, № 4. - P. 375—381.
  22. Stygar D. et al. Increased level of matrix metalloproteinases 2 and 9 in the ripening process of the human cervix // Mol. Hum. Reprod. - 2004. - Vol. 7, № 9. - P. 881—886.
  23. Young G.L., Jewell D. Interventions for leg cramps in pregnancy.
  24. Cochrane database of Systematic Reviews 2002; Issue 1. Art. No.: CD000121. doi: 10.1002/14651858.CD000121.

Arquivos suplementares

Arquivos suplementares
Ação
1. JATS XML
Baixar

Este site utiliza cookies

Ao continuar usando nosso site, você concorda com o procedimento de cookies que mantêm o site funcionando normalmente.

Informação sobre cookies